INFECTION CONTROL
Stop surgical site infections
Patients undergoing major surgery shouldn't have to worry about the risk of preventable postoperative complications. For one such complication-surgical site infections (SSIs)-the solution may be to administer antimicrobial drugs in the hour before surgery, according to a recent study published in Archives of Surgery.
Just over half the 34,000 surgical patients included in the study received a prophylactic antibiotic in this timeframe. Another 10% received antibiotics too soon-as long as 4 hours before surgery, which offers no prophylactic benefit.
What's worse, over half the patients in the study continued to receive antibiotics more than 24 hours after surgery, when the risk of infection was minimal. Powerful antibiotics were often administered unnecessarily in such cases. Improper antibiotic use, the researchers noted, can lead to antibiotic-resistant infections.
Because SSIs can be so deadly-they triple the patient's risk of dying-the researchers concluded that a significant opportunity exists to improve the use of prophylactic antibiotics in patients undergoing major surgery.
ANTIDEPRESSANTS
No need to be blue
Depression, not its treatment, may be responsible for the increased risk of myocardial infarction (MI) in patients taking antidepressants, according to a study published in the British journal Heart.
The researchers investigated the impact of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) on the risk of first acute MI in patients in 644 general practices throughout England, Scotland, Wales, and Northern Ireland. More than 60,000 patients had suffered their first MI between 1998 and 2001. Their antidepressant use was compared with that of 360,000 controls randomly selected from the United Kingdom General Practice Research Database.
The researchers found that although there was an initial increased risk of MI after starting TCA or SSRI therapy, the risk fell significantly after patients had taken antidepressants for more than a month. Once the researchers factored in cardiovascular disease and depression, the drug-associated increase in MI risk disappeared.
The bottom line for your patients: Taking an antidepressant isn't likely to put them at greater risk of an MI.
DIABETES
New injectable drug approved
The Food and Drug Administration has approved pramlintide acetate (Symlin) to help control the blood glucose level in adults with type 1 and type 2 diabetes. This injectable drug is indicated for use with insulin therapy in patients who can't achieve adequate blood glucose control on intensive insulin therapy alone. Symlin, manufactured by Amylin Pharmaceuticals, Inc, San Diego, CA, is the only therapy besides insulin now available to treat type 1 diabetes.
Patients shouldn't use this drug if they can't tell when their blood glucose level is low, if they have gastroparesis, or if they're allergic to pramlintide acetate, metacresol, D-mannitol, acetic acid, or sodium acetate. Common adverse effects of Symlin include nausea, vomiting, abdominal pain, headache, fatigue, and dizziness.
Symlin has not been evaluated for use in pediatric patients.
HEART HEALTH
Don't ignore leaky valves
If your patient has asymptomatic mitral regurgitation, you may not think of him as a candidate for cardiac surgery. But a new study from the Mayo Clinic suggests that patients with severely leaky heart valves are in danger and should be considered for surgery to correct the problem. Your asymptomatic patients may have better outcomes if they don't wait for heart failure to occur, according to the study.
Researchers followed a total of 456 initially asymptomatic patients from 1991 to 2002; eventually, 230 participants underwent heart surgery for valve repair or replacement. The size of the hole in the valve is the strongest indicator of patient outcome, the researchers said: Defects the width of a pencil or more had the poorest outcomes.
The researchers recommended that immediate cardiac surgery be considered for patients with a mitral valve hole of at least 40 mm2.
DID YOU KNOW?
[black small square] The Journal of the American Geriatrics Society reports that a 30- to 120-minute afternoon nap may help older adults compensate for some of the sleeping problems associated with aging.